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Background: Recent BSR guidelines for conventional DMARD monitoring have focused on the importance of liver function assessment in RA. The primary objective of this analysis was to determine the prevalence and severity of liver biochemical abnormalities in a contemporary RA cohort on DMARD therapy. Methods: Using routinely captured data from electronic patient records at a large tertiary rheumatology service between 2008 and 2016, we identified four cohorts of RA patients: methotrexate monotherapy; sulfasalazine monotherapy; leflunomide monotherapy; combination therapy of two or more of these drugs. Patients included in the combination cohort were either initially commenced on combination therapy or transitioned to combination therapy. Abnormal liver biochemistry was defined as AST>50 UI/l or an albumin <30g/L. Incidence rates of liver biochemical abnormalities were calculated for each drug and a Cox regression model used to compare across drug classes. Results: The total patient exposure time was 1630 years across the four cohorts. Compared to methotrexate therapy, Cox modelling revealed no significant differences in AST abnormalities with sulfasalazine, leflunomide or combination therapy. Combination therapy had a lower incidence of AST abnormalities than any monotherapy regimen. Between monotherapy regimens, the incidence of AST abnormalities was highest with sulfasalazine therapy. Individual case record analysis of 31 patients with AST values >100IU/L identified one patient with confirmed DRESS syndrome related to sulfasalazine monotherapy, seven patients with drug-related hepatic toxicity and five cases attributed to serious infection. Only 2 patients had albumin levels less than 30g/L, one in each of the sulfasalazine and leflunomide cohorts. Conclusion: In our real-life contemporary RA cohort, there were no significant differences in incidence rates of AST abnormalities between patients in monotherapy groups compared to combination therapy. We acknowledge the possibility of channelling bias and a healthy user effect, whereby patients who tolerate monotherapy without hepatotoxicity are more likely to escalate to combination therapy. These finding have interesting clinical implications as the perceived risk of liver abnormalities with combination therapy may be overestimated. Disclosures: The authors have declared no conflicts of interest.

230 Liver function abnormalities on conventional DMARDs: results from a contemporary cohort